Healthcare Provider Details

I. General information

NPI: 1528708047
Provider Name (Legal Business Name): EDWARD KENJI HADELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST STE 700
SAN FRANCISCO CA
94102-1415
US

IV. Provider business mailing address

490 POST ST STE 700
SAN FRANCISCO CA
94102-1415
US

V. Phone/Fax

Practice location:
  • Phone: 415-362-2238
  • Fax:
Mailing address:
  • Phone: 415-362-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA208307
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA208307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: